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HYPERTENSION
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H1797
H1798
Age, yr (SD)
Height, cm (SD)
Weight, kg (SD)
Established CAD, number
Medication classification, number
ACE inhibitor
-Blocker
Calcium channel blocker
Diuretic
ACE inhibitor -blocker
ACE inhibitor calcium channel blocker
ACE inhibitor diuretic
ACE inhibitor -blocker calcium channel blocker
ACE inhibitor -blocker diuretic
Time on medication, yr (SD)
Resting SBP, mmHg
Resting DBP, mmHg
66.95.8
176.913.1
83.117.8
9
6
1
1
4
3
1
2
1
1
7.77.3
126.92.4
72.22.0
The effects of IHG training on the acute endothelium-dependent dilation response following a bout of IHG exercise are
currently unknown.
The purpose of the current study was twofold: 1) to investigate improved endothelium-independent dilation as a contributor to training-induced change in endothelium-dependent vasodilation, and 2) to examine the acute vascular responses to a
single bout of IHG in the exercised arm of persons medicated
for hypertension. On the basis of the literature, it was hypothesized that: 1) changes in the capacity of the smooth muscle to
dilate (endothelium-independent vasodilation) would not be
responsible for improved post-IHG training endothelium-dependent vasodilation in subjects medicated for hypertension,
and 2) endothelium-dependent vasodilation would be attenuated immediately following a bout of IHG exercise.
MATERIALS AND METHODS
Fig. 1. Schematic diagram of testing protocol. IHG, isometric handgrip; BA, brachial artery; NTG, nitroglycerin; FMD, flow-mediated dilation.
AJP-Heart Circ Physiol VOL
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H1799
DISCUSSION
Pre-FMD
Brachial artery diameter, cm
Heart rate, beats/min
Mean arterial pressure, mmHg
Mean blood flow, ml/min
Shear rate, s1
Conductance, mlmmHg1min1
Resistance, mmHgml1min
Post-FMD
Heart rate, beats/min
Mean arterial pressure, mmHg
Conductance, mlmmHg1min1
Resistance, mmHgml1min
Peak reactive hyperemic blood
flow, ml/min
Peak shear rate, s1
Pretraining
Posttraining
0.430.01
55.82.7
95.92.5
23.02.1
25.22.3
0.20.03
4.60.3
0.430.01
54.71.7
91.93.4
22.92.0
24.61.6
0.20.02
4.40.4
58.12.7
96.62.6
2.50.1
0.40.03
55.82.1
91.24.0
2.80.2
0.40.03
238.914.3
256.312.5
248.221.1
269.119.8
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heart cycle was recorded at the following postnitroglycerin administration time points to ensure the capture of peak brachial artery
dilation: 2, 2.5, 3, 3.10, 3.20, 3.30, 3.40, 3.50, 4, 4.30, and 5 min (5).
Measurement protocol. Off-line measurements of brachial diameters were made by the same ultrasonographer using custom-designed,
automated edge-detection software to minimize observer bias (Artery
Measurement System II version 1.133, Chalmers, Sweden). All diameters were expressed as a percent increase of the baseline value of the
diameter and then normalized to the peak shear rate experienced in
response to the FMD stimulus using previously described methods
(27).
Pre- and post-FMD blood velocity samples were used to calculate
resting and peak reactive hyperemic blood flow, where pre-FMD
velocity samples were 10 s in length, and peak reactive hyperemic
blood velocity was defined as the largest single-beat mean blood
velocity following release of the occlusion cuff (excluding the first
beat). All blood velocity measurements were analyzed as previously
described (27). Measurements of heart rate, mean arterial blood
pressure [(2 diastolic blood pressure) (systolic blood pressure)/
3], vascular conductance (mean blood flow/mean arterial pressure),
and vascular resistance (mean arterial pressure/mean blood flow) were
calculated during the pre-FMD and peak reactive hyperemic blood
flow phases. In accordance with the views of Monahan and colleagues
(25), both vascular conductance and vascular resistance variables
were calculated and reported due to the debate over which variable
more accurately represents changes in vascular tone. For calculation
of endothelium-independent vasodilation, brachial artery diameters
were measured at end diastole in each of the 11 postnitroglycerin
brachial artery images and then averaged (5, 32). Endotheliumindependent dilation was expressed as a percent increase of the
baseline value of the diameter.
Statistical analysis. The effects of IHG exercise on resting endothelial function were determined by analyzing the before-IHG exercise FMD and endothelium-independent dilation data using one-way
(time) analysis of variance with repeated measures. To examine the
acute cardiovascular and vascular reactivity responses to IHG exercise
and ascertain any training effects, before-IHG exercise and after-IHG
exercise FMD data were analyzed by using two-way analysis of
variance with repeated measures (FMD test training). Tukey post
hoc procedures were used to evaluate specific differences between
means, where applicable. All data were analyzed using STATISTICA
(version 6.0), and an level of 0.05 was considered statistically
significant. Descriptive data are presented as means SE, unless
otherwise specified.
H1800
Table 3. Cardiovascular and vascular reactivity characteristics before and after a bout of IHG exercise
Pretraining
Variable
Before IHG
After IHG
Before IHG
After IHG
0.430.01
55.82.7
95.92.5
23.02.2
25.22.3
0.20.03
4.60.3
0.430.01
57.52.6*
97.32.3
41.47.3*
41.95.2*
0.40.08*
3.30.4*
0.430.01
54.71.7
91.93.4
22.92.0
24.61.6
0.20.02
4.40.4
0.430.01
56.12.3*
93.83.3
33.33.8*
34.12.3*
0.30.04*
3.40.4*
58.12.7
96.62.6
2.50.1
0.40.03
3.10.4
238.914.3
256.312.5
59.02.9
96.52.7
2.81.1*
0.40.05
2.10.4*
276.923.1*
286.921.0*
55.82.1
91.24.0
2.80.2
0.40.03
5.00.7
248.221.1
269.119.8
57.32.2
94.13.2
3.10.2*
0.350.03
3.30.6*
293.524.6*
307.615.9*
Values are means SE; n 17 subjects. *Significantly different from before-IHG exercise brachial artery FMD test (main effect for time, P 0.05).
in the brachial artery of the exercised limb. Because endothelium-independent vasodilation did not change with 8 wk of
IHG training, inherent changes in the capacity of the vascular
smooth muscle to dilate (regardless of the influence of endothelial factors) were ruled out as the mechanism responsible for
these training-induced improvements in brachial artery FMD.
To our knowledge, this is the first study to demonstrate that a
single bout of IHG exercise acutely reduces brachial artery
endothelium-dependent vasodilation in persons medicated for
hypertension. This latter observation is particularly remarkable, because IHG performed at 30% maximal voluntary contraction is such a small stimulus, yet it is sufficient to acutely
impair brachial artery FMD and improve resting endotheliumdependent vasodilation after repetitive exposure to the stimulus
over an 8-wk period.
Effects of IHG training on resting endothelium-dependent
and -independent vasodilation. Brachial artery FMD has become a popular noninvasive method to measure shear stressinduced dilation after a 5-min period of ischemic forearm
occlusion and is quantified as an index of endothelium-dependent vasodilation (5). Although our IHG protocol had four,
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Pre-FMD
Brachial artery diameter, cm
Heart rate, beats/min
Mean arterial pressure, mmHg
Mean blood flow, ml/min
Shear rate, s1
Conductance, mlmmHg1min1
Resistance, mmHgml1min
Post-FMD
Heart rate, beats/min
Mean arterial pressure, mmHg
Conductance, mlmmHg1min1
Resistance, mmHgml1min
Relative brachial artery FMD, %
Peak reactive hyperemic blood flow, ml/min
Peak shear rate, s1
Posttraining
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H1801
H1802
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